A Scoping Review of Student Pharmacist Participation on Interprofessional Rounds

Interprofessional rounding is a common, yet unrequired, part of the pharmacy experiential curriculum. Little is known about the optimal interprofessional rounding structure for student pharmacists. A scoping review was performed to assess the amount and type of information available regarding student pharmacist participation on interprofessional rounding teams. A comprehensive review of five databases was completed through May 12, 2023. A total of 20 studies met the inclusion criteria. All of the assessments performed were quasi-experimental, and the majority were non-comparative studies that described the type and amount of student interventions. A review of outcomes found that all of the studies could be grouped into two overarching categories: those that assessed the benefits of interprofessional rounding to student pharmacist competencies or satisfaction and those that assessed the benefits of student pharmacists to patient care. The benefits of interprofessional rounding on student pharmacist learning and satisfaction were assessed by qualitative analysis, surveys, and student ability assessments. The benefit of student pharmacist participation in interprofessional rounds to patient care was assessed solely by a review of clinical intervention type and quantity. Thirteen of the studies described the frequency of student pharmacist participation in rounding. Of these studies, eight described daily rounding, and five described non-daily rounding. There are few studies that describe student pharmacist participation on interprofessional rounds and assess the benefits of that participation to either the patient or the student. There is a need for more high-quality studies to determine whether there is an optimal interprofessional rounding schedule.


Introduction And Background
Interprofessional work is a cornerstone of healthcare, specifically of pharmacy practice.It is a required component of a pharmacy curriculum and is part of the Accreditation Council of Pharmacy Education (ACPE) standards [1].Interprofessional and team-based work is also part of the Interprofessional Education Collaborative (IPEC) core competencies, as well as the Curriculum Outcomes and Entrustable Professional Activities (COEPA) recommendations [2][3].Pharmacy is not the only profession to include interprofessional education as a standard.It is also part of the 2021 Accreditation Commission on Colleges of Medicine (ACCM) medical school standards [4].
A large part of interprofessional work is done within the experiential portion of the pharmacy curriculum, specifically on introductory pharmacy practice and advanced pharmacy practice experiences (IPPE, APPE).Since clinical rounding is a requirement of the ACCM standards and is a common occurrence at teaching hospitals, interprofessional rounding is often a good option for pharmacist preceptors seeking to provide an interprofessional team experience for students on inpatient APPE [4].Although the benefits of interprofessional collaboration are known through anecdotal experiences, there is a limited amount of quality data showing benefits for interprofessional rounding teams on patient care [5].Despite this lack of data, it remains the standard in many hospital systems, especially those associated with medical colleges or universities.However, interprofessional rounding teams are not universal and are often not a part of small or rural hospital practice [5][6].While there is considerable literature for medical students on clinical and interprofessional rounds, there is no corresponding review for pharmacy students [7].
The ACPE standards, as well as the IPEC and COEPA guidelines, do not specify interprofessional rounding as a requirement [1][2][3].Interprofessional rounding is a method that incorporates various healthcare professions to provide patient care in a simultaneous fashion.It is not the only way for students to gain interprofessional and teamwork experience, with data supporting brief interprofessional shadowing experiences, simulation activities, and other structured interprofessional activities [6,8].The lack of standardization often leads to uncertainty for potential preceptors, with questions such as "How do I provide the best experience?" and "Should I design my rotation similar to how I was trained or try something different?".Without data, often old routines are continued.In order to provide guidance to preceptors seeking to try innovative interprofessional rounding techniques, and to help provide data to the dogma, this scoping review was performed to collect and analyze all available data on outcomes associated with student pharmacists on interprofessional rounds.

Review Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-SCr) guidelines were used for the design and reporting of the review.Since a limited amount of published data was anticipated, a scoping methodology was utilized to incorporate literature from a wide variety of sources, including grey literature.A systematic search of six databases, MEDLINE (Ovid), EMBASE (Ovid), Web of Science (Clarivate), ERIC (Ebsco), and Academic Search Complete (Ebsco), was performed between May 9 and 12, 2023, using a combination of interprofessional rounding terms.These terms were selected to answer the research question: "What evidence is available that supports pharmacy student participation on interprofessional rounds?".The MEDLINE search strategy is provided in the Appendices.The other databases were searched using the same combination of terms, which included terms related to clinical rounds and pharmacy students.These databases were chosen to provide a thorough review of medical and educational databases and have been used in other pharmacy education-based scoping reviews [9].In addition, the reference lists for each of the final included publications were reviewed.
Articles that described results from studies assessing student pharmacists on interprofessional rounding teams were included, for all dates prior to the search dates.In anticipation of limited published data, an expansive definition of interprofessional rounding, defined as the pharmacy student and one other profession, was used.Anticipating limited randomized controlled trials, there were no exclusion parameters based on the type of study.Non-English language manuscripts, manuscripts that did not include an evaluative component, studies that assessed simulation-based activities, studies that did not include inperson, interprofessional clinical rounding activities, and studies that did not involve student pharmacists were excluded.
Title and abstract review was first performed for every database by both authors to remove sources that did not meet the inclusion criteria or were duplicates.After the initial title and abstract review, the full text of eligible articles was screened by both authors according to the same exclusion criteria.Any discordant results were discussed between both of the authors, with a decision made by consensus after a second review of the study.Data extraction was performed using a coding guide that included information on study design, setting, participants, rounding details, and outcomes.Discrepancies in data interpretation were discussed between both authors until a consensus was obtained.Study-based synthesis was limited due to the few number of studies found.

Discussion
This is the first review that focuses solely on the data supporting pharmacy students' participation on interprofessional rounds and provides a foundation for pharmacist preceptors who are interested in trying novel interprofessional rounding techniques.A recently published secondary analysis of a scoping review of inpatient interprofessional activities includes three of the studies included in our review [6].However, the difference in search terms and date limits provides a distinction between the reviews, with this review a more focused assessment of student pharmacists on interprofessional rounding teams.
While there are reviews that describe the data for clinical rounding for medical students, there is a limited amount of published information regarding student pharmacist participation in interprofessional rounds [7].
In anticipation of a limited amount of data, an expansive definition of interprofessional rounding, defined as the pharmacy student and one other profession, and a scoping review strategy were utilized.Even with these options, our search found only 20 studies, with the majority of studies originating from university and teaching hospitals.The lack of data from smaller, community, and rural hospitals could be due to a difference in the type of interprofessional interactions done at those facilities or could reflect a lack of resources to support research and publication.Because of the lack of available data, we do not know to what extent rounding is available as a learning experience for student pharmacists in non-academic practice settings.Practice sites with limited pharmacy staff or small patient volumes (e.g., critical access hospitals) are not represented in the available data.
The overall quality of assessments completed was low, with all of the data derived from quasi-experimental studies and several lacking a comparison group.This lack of rigor is not just a concern with pharmacy studies and has been noted in data supporting interprofessional collaboration and education in general [5,30].A Cochrane review on the benefits of interprofessional collaboration found a very limited number of randomized studies, which limited the conclusions [5].Within the larger arena of interprofessional collaboration and education, there is a need for data from a wider variety of practice types and locations, as well as higher-quality data.
Even though ACPE standards do not mention rounding as a requirement for APPEs, the majority of studies that mentioned rounding schedules described daily rounding.This is not surprising, since many interprofessional teams utilize a daily rounding schedule, based on an acute-care physician rounding model.However, we also found several studies that described a non-daily rounding schedule.All of these studies provided data on student-focused outcomes, such as confidence, interprofessional competency, or satisfaction with the experience.Given this information, there could be flexibility in rounding schedules, depending on the goals of the site and preceptor.Future research into the reasoning behind the preceptor's choice of a rounding schedule will help clarify why a certain schedule is utilized.In addition, increasing awareness of non-daily and non-traditional rounding options may increase the confidence of pharmacists at smaller or rural sites to provide learning opportunities to student pharmacists.
Another area of future study is the balance between the pros and cons of participating in interprofessional rounds.Is there a point at which the stress of preparing for and participating in rounds outweighs the benefit that the students gain by participating in rounds?How much do students hone their communication skills, teamwork skills, and application of clinical knowledge during activities outside of interprofessional rounds?Students may reach a maximum threshold of interventions performed; is there also a threshold at which the benefit of participating in rounds is outweighed by possible drawbacks, such as stress, burnout, and inability to participate in other clinical activities [11]?Continued research with a focus on student learning outcomes is needed.

Conclusions
There are few studies that describe student pharmacist participation on interprofessional rounds.This review found that the outcomes studied can be divided into benefits to the student and benefits to the site or patient.There is a need for more high-quality studies to determine whether there is an optimal interprofessional rounding schedule.Future research should prioritize data from small, community hospitals.

TABLE 1 : Studies that describe student pharmacist participation on interprofessional rounds
a: benefit to student learning or satisfaction; b: benefit to patients or practice site